Eight standard transactions were adopted for Electronic Data Interchange (EDI) under HIPAA. Which of the following is NOT included as a standard transaction?
a. Payment and remittance advice
b. Eligibility in a health plan
c. Coordination of benefits
d. Physician unique identifier number - AN...
AAPC CPB Chapter 1-5 Exam 100%
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Eight standard transactions were adopted for Electronic Data Interchange (EDI) under
HIPAA. Which of the following is NOT included as a standard transaction?
a. Payment and remittance advice
b. Eligibility in a health plan
c. Coordination of benefits
d. Physician unique identifier number - ANSWERSd. Physician unique identifier number
A physician received office space at a reduced rate for referring patients to the
hospital's out- patient physical therapy center. What Law does this violate?
a. Anti-Kickback Statute
b. Stark Law
c. False Claims Act
d. Truth in Lending Act - ANSWERSa. Anti-Kickback Statute
One of the most severe penalties that can be associated with violations of the Social
Security Act is exclusion from federal health care plans. Which of the following
statements is true of excluded individuals?
a. Physicians that have been excluded can bill the patient for services but cannot bill
federal health plans.
b. Physicians that have been excluded can refer their patients to other facilities for
treatment.
c. Physicians that have been excluded are prohibited from billing for any services to a
federally administered health plan.
d. Physicians that have been excluded are exempt from billing for services but are
allowed to write prescriptions and order tests. - ANSWERSc. Physicians that have been
excluded are prohibited from billing for any services to a federally administered health
plan.
A claim is received by a payer that subsequently requests the medical records for the
date of service on the claim. What procedure should be followed by the practice?
a. Only the date of service on the claim should be sent to the payer. The records can be
sent as part of HIPAA based on treatment, payment, and operations (TPO).
b. The records for the claim can be sent after authorization is received from the patient.
c. The entire patient record should be sent as part of HIPAA based on treatment,
payment, and operations.
,d. The payer is required to provide authorization signed from the patient prior to
requesting the medical records. - ANSWERSa. Only the date of service on the claim
should be sent to the payer. The records can be sent as part of HIPAA based on
treatment, payment, and operations (TPO).
HIPAA requires that privacy practice notices be provided in several circumstances.
Which if the following is NOT required?
a. Must be available on any website the practice maintains
b. Must be provided upon request
c. Must be presented to all patients
d. Must be placed into the patient's file - ANSWERSd. Must be placed into the patient's
file
The regulation of finance charges or interest applied to outstanding balances in the
medical practice is under what law?
a. Truth in Lending Act
b. Criminal Health Care Act
c. HIPAA
d. Conditions of Participation - ANSWERSa. Truth in Lending Act
Federal healthcare plans include what payers?
a. Blue Cross, Medicare, Humana
b. Medicare, Medicaid, TRICARE
c. Medicare, TRICARE, Blue Cross
d. Humana, VA, TRICARE - ANSWERSb. Medicare, Medicaid, TRICARE
HIPAA of 1996 includes a Security Rule that is established to provide what national
standards for protecting and transmitting patient data. Which of the following is NOT
true.
a. The Security rule applies to health care providers, health plans, and any covered
entity involved in the care of the patient.
b. The Security Rule applies only to the entity that initiates the release of protected
health information.
c. Standards for storing and transmitting patient data in electronic form includes portable
electronic devices.
d. The Security Rule states that safeguards must be in place to prevent unsecured
release of information. - ANSWERSb. The Security Rule applies only to the entity that
initiates the release of protected health information.
All entities are responsible for the protected health information, including the entity
receiving the information. Portable electronic devices such as tablets and smart phones
are to be made secure with passwords that are not shared between staff.
,When a subpoena is received by the practice for medical records, in what
circumstances may the records be released according to the HIPAA Privacy Rule?
a. The subpoena allows for the release of the medical records.
b. The subpoena is accompanied by a court order or the patient is notified and given a
chance to object.
c. The individual must sign an authorization for release of the information.
d. Records cannot be released under any circumstance based on a subpoena. -
ANSWERSb. The subpoena is accompanied by a court order or the patient is notified
and given a chance to object.
A physician billed claims to Medicare and Medicaid for procedures that were not
performed on 800 patients resulting in loss of 2.6 million dollars. Is this fraud or abuse?
a. Fraud; subject to the Anti-kickback Statute
b. Fraud; subject to the False Claims Act
c. Abuse; subject only to education of the provider
d. Abuse; subject to the Stark Law - ANSWERSb. Fraud; subject to the False Claims
Act
01 - ANSWERSPharmacy**
02 - ANSWERSUnassigned
03 - ANSWERSSchool
04 - ANSWERSHomeless Shelter
05 - ANSWERSIndian Health Service Free-standing Facility
06 - ANSWERSIndian Health Service Provider-based Facility
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